Doctor feel good

Oliver Sacks' new book details the varieties of hallucinations – and his own drug use

Oliver Sacks is one of the great scientific writers of our time. The author of neurological case studies like The Man Who Mistook His Wife for a Hat and Awakenings (which was also made into a film starring Robin Williams), Sacks turns the brain's glitches into high literature. He recently published Hallucinations (Knopf, 352 pages), which, in addition to offering an encyclopedic discussion of the varieties of hallucination, details his own shockingly extensive experimentation with drugs.

In the 1960s, Sacks smoked pot, shot morphine, and took LSD, morning-glory seeds and massive amounts of amphetamines. During one acid trip, he wondered what true indigo looked like and hallucinated the "pure" color; later, on a weekend-long speed bender, he read the work of the great 19th-century neurologist Edward Liveing and began to think he was Liveing: "At times I was unsure whether I was reading the book or writing it."

Previously, he had come down from his trips feeling like "I had made a crazy ascent into the stratosphere but had come back empty-handed." This time, however, he retained his insight:
"Bit by bit, I started to write my own book. The joy I got from doing this was real – infinitely more substantial than the vapid mania of amphetamines – and I never took amphetamines again."

With your new book, Hallucinations, I was wondering what, at this point in your life, made you feel that it was important to go back and talk about your more youthful experiences using drugs and that sort of hallucination.Oliver Sacks: First I should say that that scandalous Chapter 6 was not envisaged originally as part of the book. The book was basically going to be on my clinical experience, seeing people with migraines or impaired vision or Parkinson's or whatever and their hallucinations. And this is a subject that has interested me for a very long while: I wrote about musical hallucinations in Musicophilia and back, in fact, in The Man Who Mistook His Wife for a Hat. But it seemed to me time to have a go at bringing the whole subject together. For myself, I've never hesitated to regard myself as a clinical subject like my patients. Here, I had a variety of experiences and they were a long time ago and I can think of them in tranquility and recollect, and as an insider, I can add things that wouldn't be evident as an outsider. I can say how indigo seemed to me, for example.

In the climax of that chapter, you quit taking drugs and start writing. So that was obviously a transitional moment in your life. Do you feel like you've lived up to what you expected or done what you wanted at that moment?
The only ambitions there were to write a book on migraine. … Whether drugs played an essential role in that transition, I don't know and I'm actually inclined to doubt. I like to think I'd been turned on already by seeing these patients and the idea of writing a book about them would have come to me anyhow. But it came in a slightly explosive and most likely manic form on the amphetamine. I can't say whether the rest of my life has lived up to things. I never had any expectations. I find myself surprised pleasantly and unpleasantly all the while.

Reading about all of the neurological disorders in your books, one thinks: This could happen to any of us. It's almost scary. Having suffered migraines yourself, do you ever have this kind of fear?
Since you mention it, I only get visual migraines, and I had one last night, after the sensory overload of The Book of Mormon, which I think is brilliant and funny and joyous but which, for me, has unbearable acoustic intensity and brilliance of light, and I think my poor brain had a migraine in reaction to that. When Awakenings was published, people said it shows one what a knife-edge we live on. But although anything can happen at any time, mostly it doesn't.
But yes, combining neurology with hypochondria can be a fearful mixture.

There is such a sense of clinical rigor and also human warmth and concern in your writing. Do you feel that this sense has become more prominent, or that there has been a greater growth of detached treatment and statistics?
In 1967-68, when I was writing Migraine, I was somewhat horrified by the current papers and publications on the subject, but in '68 there was a book that was an epiphany for me, A.R. Luria's The Mind of a Mnemonist. I read the first few pages thinking it was a novel, because it has all the power and poignancy and pathos of a novel. But then I realized it was a case study, one of the most detailed I'd ever read. Luria himself, in his autobiography, talks about his feeling that the art of observation and description that was common to the great neurologists and psychologists of the 19th century is almost gone now and must be regained. And he had regained it himself, and I've tried to regain it. One needs statistics – one couldn't have indicted the evils of smoking without such statistics – but one also needs single case histories which are very detailed not only on the pathology but on the person.

In terms of style, you really strike me as one of the masters of the footnote. Yours are more like that great one in William James' The Principles of Psychology – where he tells readers how to go get a lamb and crack open its skull to examine its brain – whereas most scientific footnotes simply refer you to other studies. Is that a conscious thing?
I don't think of them in terms of literary style, but I have multitudes of thoughts bursting on me and I fear they would explode the argument or description, so excursions of every sort can be made with footnotes. A good friend of mine, Jonathan Miller, says I suffer from commentarrhea. But I find it difficult to write without footnotes. In one of my books, Island of the Colorblind, footnotes end up taking up a third of the text.

After a lifetime of doing this kind of research, were there still things that surprised you about hallucinations?
Quite a lot of them. A single small one which intrigued me was people who have hallucinations of musical notations, though typically they can't sing or play what they see because it's too elaborate and complicated. I had hardly heard of near-death and out-of-body experiences, but I am writing more about them now. I was fascinated about how rich hallucinations of smell can be, and I am fascinated by the way that they can extend beyond imagination: The variety of faces one may see in a hallucinations are endless. The brain's ability to invent comes up very strikingly in hallucinations.

Are you working on a new book? Do you have a new obsession?
I don't know whether I have a new obsession or not. I wonder whether, instead of long, extended case histories, I might put together a book of them that are only a paragraph or two in length. I must have heard hundreds, even thousands of odd stories and observations. I have been wanting to put together some essays on memory and creativity. I've also wondered about some non-medical writing. I've been an assiduous keeper of journals, especially travel journals, since I was 14, and I would wonder about putting some of those together. So I'm actually not quite sure what comes next.